I saw a pleasant but very worried 40-something woman a few weeks ago who had written on her intake form “Candida!” “Food allergies!” and “I don’t know what to eat!” To be honest, she didn’t look particularly healthy, likely because she was both poorly nourished and depressed.
Her story is provocative. Many months earlier, feeling tired and depressed, her digestion a bit off and having occasional headaches, Beth began to worry something serious might be going on. She went to her conventional internist, who did a complete physical exam (everything normal) and ran a battery of tests to screen for illnesses of every stripe. Nothing came up positive. She wasn’t achy enough to warrant a fibro diagnosis or sufficiently fatigued for chronic fatigue syndrome, but she did get irritated when her doc suggested she might be depressed and offered a referral to a psychologist and antidepressants. Sitting with me months later, remembering how swamped she was by stress, Beth acknowledged that her internist might have been right. But now there was even more…
Visiting a health food store, the clerk had suggested Beth might have candida, so she went online, took a “diagnose-it-yourself” screening test, and became convinced this was her issue. The website sold her some supplements and insisted she follow the highly restrictive anti-candida diet. Within a few weeks, Beth thought she might be feeling a shade better (actually, most people do when they reduce their sugar intake, the centerpiece of the anti-candida diet), but in the process she’d eliminated so much food she began to worry about her health.
Next Beth visited a nutritionist who simply accepted her patient’s self-diagnosis of candida without confirming it. Then, with no additional testing, she told Beth the candida had triggered “leaky gut” and that she’d developed hidden food allergies. Her diet needed to be restricted even further. Beth was nearing the precipice of what I once named the “brown rice, kale, and water diet,” after a patient I’d seen many years ago who came in having reduced her eating to those three foods only. That patient had been convinced she’d developed allergies to everything else and was virtually starving herself.
As my new patient Beth read more and more about the dangers of food, she felt overwhelmed. She soon became vegetarian and a few weeks went all out to become a strict vegan. Then she started to obsess about chemicals and preservatives and after eliminating them lay awake at night worrying that hidden GMOs (genetically modified organisms) might be entering her DNA. With veganism, she also became an animal rights activist. I asked if she’d ever seen the lists of endangered fish. She laughed and said she gave out laminated cards listing these fish whenever she met friends at a restaurant (did I want one?). I wondered to myself if her well intended nannying cut down on social invitations.
While Beth’s case is admittedly extreme, situations like hers are becoming more common as people suffer under the occasionally dangerous cumulative effect of serial specific nutrition recommendations. There’s been no shortage of patients describing one or more self-imposed restrictions that have deprived them of once well-liked foods, limited their social circle (turning down dinner invitations, avoiding restaurants), or caused difficulties on the home front. With the food restrictions, these patients clearly weren’t enjoying themselves and there’d been no discernible improvement in their overall health. Nevertheless, they thought about food constantly and felt deeply guilty when they cheated on whichever strict diet they were following by capitulating to a food they’d once loved but hadn’t tasted for months. Beth herself had developed significant deficiencies of vitamins B-12 and D as well as several essential amino acids (the building blocks of proteins needed throughout your body).
The term for this situation is orthorexia nervosa. The word “orthorexia” is derived from the Greek, meaning “correct eating.” You’re probably more familiar with “anorexia nervosa,” the word “anorexia” being a medical term for having no appetite.
I wrote about orthorexia nervosa several years ago, reviewing a 2001 book called Health Food Junkies, by Stephen Bratman, MD, a physician who realized with the help of his psychologist brother that he’d developed the condition himself. Now, 12 years later, you can easily find articles about orthorexia nervosa on many conventional medical websites.
As Dr. Bratman discovered after his book was published, people who are acutely concerned about what they eat (well beyond the pleasure it might give them) can be extremely defensive and angry when someone suggests they might be overdoing it. On Dr. Bratman’s website, he even includes a link reprinting some of the hate mail he received as a consequence of his book.
When patients arrive at WholeHealth Chicago on brutally and unnecessarily restrictive diets, I gently encourage them to reintroduce foods they once loved. If they’re restricting foods because of candida, for example, I suggest testing for it to make sure they’ve made an accurate self-diagnosis. Most turn out to be candida-free and I’m perfectly happy to credit their diligence with clearing it up, advising that they no longer have to continue the severe cutbacks.
Could you be an accidental orthorectic?
Some of the “natural medicine” websites are so fear-mongering the only things left for you to chew are your fingernails. Here’s a quick quiz devised by Dr. Bratman to determine if you might be an inadvertent victim of orthorexia nervosa. If you think you might be suffering from orthorexia nervosa, please schedule an appointment with one of our nutritionists.
• Do you spend more than three hours a day thinking about healthy food? (Scoring note: for four hours, give yourself 2 points.)
• Are you already planning tomorrow’s healthy menu today?*
• Do you care more about the virtue of what you eat than the pleasure you receive from eating it?
• Has the quality of your life decreased since the quality of your diet has increased?
• Do you keep getting stricter with yourself?
• Do you feel an increased sense of self-esteem when you are eating “right” and look down on others whose diets are not, in your eyes, healthy?
• Do you skip foods you enjoy just to eat the “right” foods?**
• Does your diet make it difficult for you to eat away from home?
• Are you becoming socially isolated?
• Do you feel guilty or hate yourself when you stray from your diet?
• When you eat the “good” foods, do you feel a peaceful sense of total control?
Give yourself one point for each “yes” answer.
• 2-3 points: You may have a mild case of orthorexia. Be aware of your behavior.
• 4-9 points: You may have a moderate case of orthorexia. You may need to relax your diet standards.
• 10 points: You are obsessed with your healthy diet. You may need to seek professional help.
*This does not mean planning a week’s menus so that you can shop for food once a week. Many people who work full time do this to make time for other activities.
**This means compulsively, whether there’s a good reason or not. Obviously someone who is trying to lose 20 pounds of body fat will need to use some self-control.
Restrictive diets are common sense
Before I talk about treatment, here’s a quick clear-the-air on restrictive diets. Useful restrictions are based in common sense: “Every time I eat gluten, I feel ill, so I avoid it,” “Shellfish makes my throat close up, so I don’t eat it.”
Others are based on someone’s opinion, without much fact to back them up: “I’ll never eat beef because I’m Type A blood,” “I never touch fish because of the mercury,” “Cooked food removes all nutrients,” “When you eat an animal, you eat its fear.”
I expect to receive a lot of blustery comments this week, but oh well.
If you don’t have a specific medical problem that requires you to change your eating (such as obesity, diabetes, heart disease, or high cholesterol), there are relatively few reasons to restrict yourself. The most common genuine reasons are:
- Food allergy This is obvious. You eat something like peanuts, shellfish, or strawberries and you break out in hives or go into shock.
- Food sensitivities These are more subtle. Certain foods bring on a variety of seemingly unrelated symptoms. Testing for these is iffy at best. However, there are just six food groups that people are sensitive to: dairy, egg, corn, gluten, citrus, and soy. If eliminating any of them improves any symptom, then don’t eat that food. You can test your sensitivity by reintroducing the food. If your symptoms return, you have an “Aha!” moment.
The most common self-imposed restriction we see is the “anti-candida” diet, which originated in The Yeast Connection, by William Crook, MD. Toward the end of his life–he died in his 90s in 2002–Crook himself acknowledged that the diet was too restrictive in view of the excellent medications that had become available and said that modest reduction of sugar (always a good idea) was really all that was needed.
As for every other conceivable restriction that people think of (and believe me, there are many), from veganism, to raw-foodism, to shunning GMOs, to obsessive avoidance of all additives, there’s really not much hard evidence that worrying about and avoiding all this stuff will improve either your health or longevity.
The simple restrictions are best:
- Avoid all fast food (period) and most processed foods.
- When you shop stick to the periphery of the grocery store, avoiding the aisles (although you’ll need to go there for toilet paper).
- Watch your portions to avoid gaining weight.
Here at WholeHealth Chicago, with the exception of a couple of practitioners who have well-documented food sensitivities, we all really like good food. We trade recipes, bring in samples of what we make at home, and exchange information about new restaurants (Drs. Maurer and Kelley are fonts of information about where to eat).
David Edelberg, MD